Links

DISCLAIMER
This is a personal web site, reflecting the opinions of its author. It is not a production of my employer, and it is unaffiliated with ANY hospital, medical center, medical practice or other physicians. Statements on this site do not represent the views or policies of anyone other than myself. The information on this site is provided for discussion purposes only, and are not medical recommendations. I offer no guarentee as to the accuracy of anything stated and the information here is at times, highly speculative and does not constitute advice to/not to diagnose or treat. Any personal medical issues the reader may have should be referred immediately to the reader's private physician and under no circumstances should anyone delay, change, or alter any medical treatment or planned treatment or diagnosis based on anything read on this site. Under no circumstances does any herein contained information represent a medical recommendation.

Starving Terri Schiavo

The Florida Supreme Court has decided that it is OK for Floridians to starve and dehydrate someone to death. This is hard to understand. RangelMD posts that Ms. Schiavo is in a persistent vegetative state with no hope of recovery and that she should be thought of as a "terminal" patient. He also avers that this case is being made a spectacle by "conservative 'right to life' forces".

These deflections miss the essence of this case, which is that we are allowing someone to be starved to death. Someone who otherwise would not die. We are not allowing her death we are actuating it. There is a big difference.

This is not a patient with widespread metastatic disease or terminal refractory, untreatable illness. This is someone who will continue to live unless we starve and dehydrate her.

It is a common practice in medicine to always treat certain conditions in terminal patients -- even those who have signed a DNR ("Do Not Resucitate") order; For example, we will not allow DNR patients to suffer sepsis, and antimicrobial therapy is used.

How then can we not feed someone? Do we really want to be starving patients? Is there not a difference between making someone comfortable during the ravages of a fatal incurable disease, and taking away food and water?

Insofar as Ms. Schiavo's mental capacities, no matter how much reduced they are (from what standard?), it is perilous to use this argument as a rationale for starving and dehydrating her. It is not a far leap from Terry Schiavo to someone who is severely retarded or demented. Who would want the task of having to draw those lines in and around humanity?

Many have adduced as evidence supporting starvation, that in her mental state, Ms. Schiavo could not possibly suffer physically or mentally from this act.

Then she cannot possibly suffer physically or mentally from its absence.

The vast majority of ethical debate (and by this I mean debate about ethics not...you get it) about enteral and parenteral supplemental nutrition has come down on the side of it being solely one of the myriad possible medical interventions, no different than a ventilator or antibiotics. Your horrified statement could equally be made about any of those interventions. For example "The Florida Supreme Court has decided that it is OK for Floridians to suffocate someone to death. This is hard to understand." or "The Florida Supreme Court has decided that it is OK for Floridians to let someone die of an infection . This is hard to understand." If you believe that Ms. Schiavo would not want to live like she is now (as did the court that heard the case) then how can you ethically continue to treat her against her perceived wishes? In abbreviated med. ethics jargon "autonomy trumps beneficence." Just because Terry is unable to resist unwanted medical care doesn't mean you have the right to force it on her. Of course if you don't believe in withdrawal of medical support under any circumstances or if you don't believe that Ms. Schiavo wouldn't want to live like this than all of the above is moot.

I also just re-read the entry and I have to say that this paragraph "It is a common practice in medicine to always treat certain conditions in terminal patients -- even those who have signed a DNR ("Do Not Resucitate") order; For example, we will not allow DNR patients to suffer sepsis, and antimicrobial therapy is used." is basically true but inaccurate. DNR is what it stands for -- if the heart stops, don't try to bring it back BUT it is NOT comfort care only. A DNR patient gets EVERY advantage of modern medicine right up until the heart stops and then nothing else. This is ABSOLUTELY not the same thing as withdrawing support on a terminal patient. It is routine in every ICU in the country that when a patient/family requests withdrawal of support (i.e. off the ventilator, stop pressors, etc.) the antibiotics stop. Sometimes it's decided that no escalation of therapy be instituted -- continue everything but don't add anything. It is flatly untrue that antibiotics never get withdrawn. To reiterate, it is unethical and ILLEGAL (assault) to treat anyone against their wishes. That's why no one forces (adult) Christian Scientists into the hospital or makes Jehova's witnesses receive blood transfusions even if they're going to die without one. If a patient or their legal representative refuses a therapy (ANY therapy) you cannot institute it or continue it. Tube feedings (like Ms. Schiavo) are ethically no different -- although emotionally they are.

"DNR orders only preclude resuscitative efforts in the event of cardiopulmonary arrest and should not influence other therapeutic interventions that may be appropriate for the patient."

Why did they issue this guideline? Because, at the time, the original debate was centered around hopelessly ill and/or terminal patients (where it should have stayed). Granted, the concept has been outrageously expanded since then, but my efforts were to draw attention to this intent.

Ms. Schiavo left no written expression of her wishes, and her own family does not recall her saying anything about the issue. The evidence of her alleged desire to die consists entirely of hearsay testimony from Mr. Schiavo, his brother, and his sister-in-law, concerning statements they say Ms. Schiavo made in casual conversation.

Fianlly:

It is my belief that withdrawing food and water is quite different from pacing someone's heart and aerating one's lungs artificially; however, that is not the ethical issue that concerns me most in this case; it is the removal of food and water from a living person who is not terminal (any more than you or me). This has GOT to bother a physician. That is my problem. It really bothers me.

Apparently Terri Schiavo expressed her "desire" not to be kept alive, in front of her husband, during a television show about Karen Quinlan.

What if she had seen a show about stem cell research showing the regeneration of neural tissue? Do you think she might have said "Gee, if I weren't suffering, and there is research like that out there...maybe staying alive peacefully on food and water might not be such a bad idea?"

If anyone is interested in some facts, please read the "Guardian's Dec. 2003 report to Gov. Bush" posted on www.OrlandoSentinel.com/schiavo

This is the 38 page report created by Dr. Jay Wolfson who was her guardian as a result of Governor Bush's Terri's Law. This report is the one the governor called for. It provides Terri's entire health history, court testimony and the opinions of the neurologists and neurosurgeons. Terri Schiavo's cerebral cortex has been replaced by spinal fluid. That alone renders her PVS.

The report found that Michael Schiavo was an attentive and loving husband to Terri. He was relentless with nursing home staff and created a scene if any part of Terri's care was amiss. Terri's parents signed over guardianship to Michael - that's how much they knew he loved her and was caring for her.

The most disturbing aspect of the Schindler's behavior has been that they stated, in court testimony, that even if Terri had expressed wishes of not wanting to be artificially nurished in her present circumstances, they still would not allow the tube's removal. Additionally, they testified that they would keep her alive "at any and all costs," even if that meant to amputate her limbs.

With parents like those, who needs enemies?

Whatever your personal views, it doesn't change the medical, scientific fact that Terri Schiavo is PVS with no hope of recovery.